What are complementary and alternative medicines
(CAMs)?

They are ways of treating illness that have
developed outside the mainstream of modern medicine. Many are
traditional remedies that have developed in different cultures over
the centuries. They include:

herbal medicines

foods

nutritional supplements, such as vitamins and minerals

All these treatments can be used on
their own, or with conventional medicine.

CAMs and mental health problems

Many CAMs have been used for mental health
problems, but there is little good evidence to support their use.
Some of these treatments may work, but most have not been
thoroughly tested. The studies have often been too small to give a
clear answer. We know most about the treatments for depression, anxiety and insomnia.

Despite the lack of evidence, people all
over the world take CAMs, and many report that they find them
helpful. Ultimately, whether taking CAMs is a good idea depends on
individual circumstances. We recommend that you talk to your GP or
mental health team first.

If you are considering taking CAMs, you should seek specialist
advice if:

you are pregnant or breastfeeding

you want to give CAMs to children

you are competing in sports to make sure that the CAM you are
considering taking is not in breach of doping regulations.

How to use CAMs
safely?

Do

choose a qualified practitioner who is a member of a recognised
society

ask about their qualification and experience

ask about side-effects

if in doubt, ask your doctor, nurse or pharmacist

tell the professionals involved in your care, including
your CAM practitioner, about all your treatments and
medications

tell them if you are pregnant, plan to become pregnant or
breast-feed

tell them about your physical health and allergies

discuss your concerns about treatment

seek medical advice if you experience unusual symptoms

make special time for your treatment sessions

find a reliable source for your information about
therapies.

Don’t

stop conventional medicines without telling your doctor

believe claims for 'wonder cures'

take high doses of supplements unless confirmed with an
experienced health professional

combine many different remedies

take complementary medicines without knowing what they
are for

take somebody else’s complementary medicines

give remedies to children without seeking specialist
advice

take remedies from an unreliable source - this includes the
internet

eat or drink raw plant material, such as flowers, fruits,
leaves, seeds or the root unless you are sure it is absolutely safe
(many plants are poisonous and need to be processed before they can
be used safely)

prepare your own teas and extracts unless you are sure it is
safe

smoke raw plant material

pay large sums of money up front

practice acupuncture or any other physical treatment on
yourself unless you have been trained

blame yourself if a treatment does not work.

Herbal remedies and supplements

Herbal remedies come from plants. If possible,
choose a remedy which has been standardised, i.e. the contents are
approximately the same in each bottle or tablet you buy. Plant
remedies are not always safer than ordinary medicines. All of them
can have side-effects and interact with other medicines.

Supplements include vitamins, minerals and
animal and plant products, such as cod liver oil. They can also
have side-effects and interact with other medicines. Some people
take supplements, like vitamin C in high doses, but this can damage
the liver or kidneys. Many supplements have a recommended daily
intake (RDI), or allowance (RDA). Do not go beyond this dose
without talking to an experienced health professional.

Brain function and dementia

These are called 'cognitive enhancers' and can
improve concentration. They include:

Ginkgo (ginkgo biloba)

Ginseng (panax ginseng)

Hydergine (Ergot) (claviceps purpurea)

Sage (Salvia officinalis, salvia lavandulaefolia)

Vitamin E (alpha-tocopheril)

Ginkgo

Ginkgo is a tree originating in China.
Extracts of its seeds and leaves are used to improve thinking in
healthy people, as well as people with dementia.

How does it work?

We don't know. It may:

act as an antioxidant to prevent cell
damage

increase the blood flow in the brain or
increase chemical transmitters in the brain.

How good is it? Research
shows that Ginkgo may help in dementia. The same is true of its use
in healthy adults, but ultimately, we do not know.

Side-effects: It may
rarely cause bleeding into the brain and into the eye or
prolong bleeding time during surgery. About twenty such cases have
been reported, and patients undergoing surgery may consider
avoiding gingko. Gingko should not be taken together with blood
thinning medications, such as aspirin and ibuprofen. There is
an increased risk of fits and lower fertility in both men
and women.

Ginseng

Ginseng grows in many parts of the world.
Panax ginseng or Korean ginseng are most commonly used.

How does it work?

We don't know. It may:

thin the blood

prevent cell damage through antioxidant
activity.

How good is it? It might
improve cognitive performance, but there is no evidence that it
delays ageing.

Side-effects: agitation and
mania; sleep problems; blood pressure changes; changes in bleeding
time so people with bleeding disorders such as stroke and blood
clots (thrombosis) should avoid it. It may possibly
stimulate breast cancers.

Drug interactions with:

drugs used in diabetes (lower blood sugar)

blood thinning agents such as aspirin, ibuprofen and warfarin
(changes in bleeding time)

MAOI antidepressants (eg. Phenelzine), may lead to
agitation and sleep problems.

Hydergine

This comes from a fungus which lives on rye.
For hundreds of years it has caused epidemics of poisoning
(ergotism). This is caused by eating bread made from infected rye
flour.

Sage

Sage produces oils which are used in
aromatherapy. It is used to improve concentration and memory
and has been suggested as a treatment of
depression and anxiety.

How does it work?

It may:

increase some brain transmitters

have antioxidant, anti-inflammatory and oestrogen effects

How good is it? There is some
evidence for improved memory in volunteers. One study found that it
improved mood, alertness, calmness and contentedness. It may help
concentration in people with dementia.

Side-effects: although safe when used in amounts
commonly found in foods, some types when taken orally can cause
convulsions. Sage may also lower blood sugar. It should not be used
in pregnancy or when breastfeeding.

Drug interactions
with:

drugs for diabetes

drugs for epilepsy

sedatives.

Vitamin E (alpha-tocopherol)

Vitamin E is found in plant oils, nuts,
vegetables and, to a lesser degree, in meat and dairy products.

How does it work?

Antioxidant properties may
prevent cell damage.

How good is it? It may
improve behaviour in dementia, but there is no good evidence that
it improves memory or slows the progress of the disease.

Side-effects: A recent study
found that a daily intake of more than 400IU (270 mg of
alpha-tocopherol) resulted in an increase of death from all causes,
and an increased risk of bleeding and stroke.

Drug interactions with:

drugs to thin the blood

anaesthetics and cocaine

drugs to lower cholesterol and some cancer
treatments.

Anxiety and Sleep Problems

Most of these treatments seem to work on
gamma-amino-butyric acid (GABA), a chemical in the
brain linked to anxiety. We do not know if these drugs cause
addiction. They are less powerful than conventional sedatives or
sleeping tablets.

Note

Kava (piper methysticum) has been withdrawn in the UK due to
concerns that it might cause liver damage. It should not be
used.

Combinations of extracts may be less safe. There have been
concerns about liver damage from combinations of valerian and other
herbs.

Remedies include

Valerian (valeriana officinalis)

Passion flower (passiflora incarnata)

German chamomile (matricaria recutita)

Hops (humulus lupulus)

Oats (avena sativa)

Starflower / borage (borago officinalis)

Lemon balm (melissa officinalis)

Lavender (lavendula angustifolia)

Bach flower remedies

Melatonin (N-acetyl-S-metoxy tryptamine)

Aminoacids

Roseroot

Vitamins, trace elements and supplements

Valerian

Valeriana officinalis is thought to be safe
and is available as a standard extract in the UK. Some other
species may
cause liver problems

How does it work?

It probably acts on GABA.

It may also counteract the effects of
caffeine.

How good is it? This remains
unclear at the moment, but some studies have shown that people
report sleeping better having taken Valerian.

Side-effects: drowsiness or
excitability. It may slow down reactions, so you should not
drive or operate dangerous machinery after taking it. Valerian is
safe more most people when used sort-term. As with most
complementary medicines, we do not know whether long-term use
may be harmful. You should not take it in pregnancy.

Drug interactions with:

sedatives

alcohol

the pill

HIV medicines

cancer treatments

epilepsy and anti-fungal treatments

blood thinning medicines.

Passion flower

Passion flower is used to treat anxiety. It has also been
suggested as a treatment in alcohol craving and opiate
withdrawal.

How does it work?

It probably acts on GABA.

How good is it? Very few
studies have been conducted, One trial found it to be as good
as conventional tranquillisers.

Side-effects: isolated
reports of severe toxicity even at normal doses. It can cause
dizziness, confusion, heart problems, and inflammation of blood
vessels. Some species may contain cyanides, so toxicity may depend
on the preparation.

Drug interactions with:

warfarin, a blood thinner.

German chamomile

Chamomile is a mild sedative. It is also used to
treat stomach upsets and mucosal irritations. Traditionally the
flowers are prepared as a tea.

How does it work?

It acts on GABA.

How good is it? We know very
little, but one recent study has shown that it may make people less
anxious, as long as the anxiety is not too bad.

Side-effects: it may
increase bleeding time and may stimulate breast cancer cell growth
in oestrogen sensitive cancers.

Drug interactions with:

blood thinning drugs

oral contraception (the pill).

Hops

Dried
hops have been used to treat anxiety and sleep problems.

How does it work?

We don't know.

How good is
it? One study showed that a valerian-hops combination
helped sleep.

Side effects: none
reported.

Drug interactions with:
increases sedation when used with:

sedatives

sleeping tablets

other herbs

alcohol.

Oats

People use this to lower cholesterol and for stomach upsets,
such as irritable bowel syndrome. It has also been used
to treat anxiety and tiredness. It has even been suggested for use
in alcohol and nicotine addiction.

How does it work? We don’t know.

How good is it? We don’t know.

Side-effects: none known.

Drug interactions with: none known.

Starflower (borage)

Starflower oil is used for rheumatoid arthritis,
premenstrual syndrome (PMS) and sedation.

How does it work?

We do not know.

How good is it? We do not
know.

Side-effects: some extracts
can cause liver problems or possibly cancer. It should not be used
in pregnancy and it may increase epileptic fits.

Drug interactions with:

blood thinning drugs such as: aspirin, ibuprofen,
warfarin.

Lemon balm

Lemon balm is a herb of the mint family. It is
used for anxiety, sleep problems, heavy periods and period pain. It
is also used to treat agitation in dementia. Lemon balm is used as
tea or extract. The oil is also used in aromatherapy.

How does it work?

It may work on brain transmitters.

How good is it? Some
evidence of calming in dementia. No research on its use in anxiety
and insomnia. In combination with valerian and hops, it can improve
sleep.

Side-effects: very
few

Drug interactions with:
increases sedation when used with:

sedatives

herbs

alcohol.

Lavender

Lavender is also a member of the mint family. Drops of
lavender oil or seeds put onto pillows have been used to help
sleep. It is used in aromatherapy, and as an extract or tea.

How does it work?

We don't know.

How good is it? May act as a
mild sedative when used in aromatherapy.

Side-effects: skin
irritation.

Drug interactions with:
increased sedation when used with:

sedatives

herbs

alcohol.

Bach flower remedies

This is an extract from a combination of flowers which is used
to treat anxiety, panic and trauma.

How does it work? We don’t know.

How good is it? No good evidence.

Side-effects: We don’t know.

Drug interactions with: We don’t know.

Melatonin

Melatonin is a hormone made by the pineal
gland in the base of the brain. It controls our body clock. If you
are over 55, your doctor can prescribe melatonin for you. The
prescribed brand is called Circadin.

How does it work?

By regulating the body clock.

How good is it? It may
improve sleep quality in older adults.

Side-effects: sleepiness and low mood.

Drug interactions with: blood thinning
drugs.

Increases sedation when used with: sedatives
and herbs.

Aminoacids

A mixture of two aminoacids - L-Arginine and L-Lysine - has been
used to try to reduce stress and anxiety.

How does it work? By modifying hormones which
are released under stress.

How good is it? Only a few studies
exist so we don't know.

Side-effects:

L-Lysine: one case of severe kidney problems has been
reported.

L-Arginine: drugs which lower blood pressure and nitrates. A
few deaths have occurred in people who had a recent heart attack.
If in doubt, avoid or seek an opinion from a heart specialist
first.

Drug interactions with:

L-Lysine: calcium supplements.

L-Arginine: drugs which lower blood pressure and nitrates.
Avoid such combination because they may make your blood pressure
fall too much. Even combination with medicines, such as
Viagra, may make your blood pressure go too low.

Roseroot

Roseroot is
also known as 'artic root' or 'rhodolia'. It is also a so called
'adaptogen' which should help the body cope better with stress,
anxiety and tiredness. Roseroot has also been used as an energy
booster, for instance to enhance athletic performance.

How does it work?

We don't know. Some components of roseroot may modify
hormones which are released under stress, others may be mildly
stimulating.

It also has antioxidant activity.

How good is it? We don't know at
present. More studies are needed to confirm the effects.

Side-effects: No serious effects reported. It
may cause dizziness or dry mouth.

Drug interactions with: None reported.

Vitamins, trace elements and
supplementsIt has been suggested that certain
vitamins, trace elements and supplements may help anxiety. However,
there are very few studies to rely on at present. One problem is
that studies tend to test combinations rather than individual
substances, so that it's difficult to tell which ingredient does
what.

The Food Standards
Agency has produced a website which explains all about
vitamins, trace elements and supplements.

Depression and Bipolar Disorder

Remedies include:

St John’s wort (hypericum perforatum)

S-adenosyl-methionine

Folic acid (Folate)

Selenium

Vitamin D

Omega-3 fatty acids

In bipolar disorder (manic
depression), adding omega-3 fatty acids may reduce the
chance of becoming ill again. Some people buy natural lithium, but
we do not recommend this because the doses offered in the
tablets are much lower than in prescription preparations.
Also, lithium at
any dose should be closely monitored.

Most treatments for depression are
supplements, which are building blocks in the production of
serotonin. This is a chemical in the brain that seems to be
involved in depression. L-tryptophan and 5 hydroxytryptophan
(5-HT), are such building blocks, but they have not as yet
been cleared as safe.

St John's wort

St
John’s wort gets its name from St John’s day on the 24th June. This
is when the plant starts to flower. For a long time it was thought
that the red dye, hypericin, which is produced when the plant is
crushed, was responsible for its action. Research now suggests that
another ingredient, hyperforin, may produce the antidepressant
effect. St John’s wort has also been suggested as a treatment of
anxiety, addiction and premenstrual stress.

How does it work?

Increases serotonin in the brain.

How good is it? It has been
shown to be effective in many trials.

Side-effects: People taking
St John’s wort may burn more easily in the sun; if in doubt use sun
screen. It may cause mania in people with bipolar disorder.

Drug interactions with:

antidepressants

strong painkillers

oral contraceptives (the pill), reduces its
effectiveness

some cancer drugs.

Can also reduce the effect
of:

some epilepsy drugs, such as carbamazepine

digoxin

warfarin

HIV drugs

some cancer drugs.

There is also a risk of organ rejection in
people taking St John's wort who undergo transplant surgery.

S-adenosyl-methionine (SAME)

S-adenosyl-methionine (SAME) is another
building block of serotonin. It is not often used in the UK, but is
popular in Europe and the US. It is also popular with HIV sufferers
because it has few side-effects. It is often given as an injection.
However, oral preparations are available, but some do not work.
SAME can be expensive.

How does it work?

It helps to produce serotonin and other neurotransmitters.

How good is it? Some
trials show that SAME has a good antidepressant effect.

Side-effects: may cause mania in people with
bipolar disorder.

Drug interactions with:

antidepressants

strong painkillers.

Folic acid (Folate)

Folic acid is used by women who want to
become pregnant or are pregnant to prevent spina bifida, a
malformation of the baby’s spine. In some countries, folic acid is
added to the flour.

How does it work?

It is another building block of
serotonin and other neurotransmitters.

How good is
it? It may increase the effect of some
antidepressants.

Side-effects: It may make it more
difficult to diagnose pernicious anaemia which can occur in people
who do not have enough Vitamin B12. Large doses can cause
agitation, sleep problems, confusion and fits.

Drug interactions
with:

some anti-cancer drugs

some antibiotics.

Selenium

Selenium is an important trace element. It is
found in vegetables, meat, fish and Brazil nuts. Brazil nuts can
vary in selenium content, but sometimes the concentration is so
high that the US National Institutes of Health advise that Brazil
nuts should be only eaten occasionally. The Food Standards Agency
recommends a safe upper level of 0.45 mg per day. Some formulations
exceed this dose.

How does it work?

Selenium is an antioxidant and may prevent
cell damage. It also helps produce thyroid hormone.

NOTE! Going out into the sunlight is a good way to stock
up on Vitamin D because the light of the sun helps our skin to
produce Vitamin D itself. And the physical activity can help to
lift low mood as well.

Omega-3 fatty acids

Omega-3 acids are mainly derived from fish –
they are used to prevent heart and joint disease. They are also
used in depression. Omega-3 fatty acids have two main components:
docosahexaonic acid (DHA) and eicosapentaonic acid (EPA). The pills
are often large, and some people find them hard to swallow. Avoid
preparations which have added vitamin A. This could cause vitamin A
poisoning.

How does it work?

Omega-3 fatty acids help to build up and
protect brain cells.

How good is it? They may be
worth taking with antidepressants. They may help prevent
relapse in bipolar disorder. There is not enough evidence to
recommend them as an alternative to antidepressants or mood
stabilisers.

Side-effects:
unknown

Drug interactions with: blood
thinning drugs.

Psychosis

Choices are limited. Rauwolfia, a plant
originating from India, has been used, but is not as good as
antipsychotic
medicines. Reserpine, a drug developed from Rauwolfia,
can cause depression and is no longer used in the UK.

Omega-3s may be tried with antipsychotic
treatment, but there is no good evidence that they help. Many
antipsychotics can cause weight gain and lead to a higher risk of
heart and blood pressure problems. Omega-3s may reduce these
changes, but success is not guaranteed.

Movement Disorders

Many older antipsychotics could cause abnormal
movements, known as tardive dyskinesia. If this occurs, the dose of
the antipsychotic can be lowered, or an alternative antipsychotic
given.

Two complementary remedies may help -
vitamin E, melatonin and ginkgo biloba.

Vitamin E, may prevent the movements getting
worse. However, the potential benefits need to be offset against
long-term use, particularly if high doses of vitamin E are
considered.

Melatonin has also been tried, but the
research is inconclusive.

One study found that Gingko biloba can reduce tardive dyskinesia
and that the effect may last for some time, even after Ginkgo
biloba has been stopped. As mentioned above, there may be health
risks because of a potentially increased bleeding risk.

Addictions

The choice is limited. Valerian has been suggested to improve
sleep in people withdrawing from drugs like Valium. But no good
research has been done. Passion flower was effective when combined
with clonidine in one small study, and St John’s wort may reduce
alcohol craving.

Other Remedies include:

Kudzu

Iboga

Kudzu

Kudzu, or 'Japanese arroweed' flowers have a
pleasant fragrance. They have been used for many medical purposes,
including menopausal problems. It has also been used for alcohol
problems.

How does it work?

It may reduce anxiety caused by alcohol
withdrawal.

How good is it? One study
showed reduction in alcohol use in heavy drinkers. Another study
failed to show any effect on craving.

Side-effects: none
reported.

Drug interactions with:

blood thinning drugs

oral contraceptives (the pill)

drugs for diabetes

Iboga/Ibogaine

Iboga is a West African shrub producing
ibogaine. This causes hallucinations and has been used widely for
religious rites. It became famous as a treatment for opiate
addiction in the 60s. However, it can have serious life-threatening
side-effects. Until these safety concerns are clarified it cannot
be recommended.

How does it work?

It probably affects several chemical
transmitters in the brain.

How
good is it? It may help in withdrawal and in
staying away from drugs.

Side-effects: Several deaths after
ibogaine use have been reported. The risk of death may be as
high as 1 in 300 treatments. It is not known how many deaths
have occurred, and may have gone unreported because
of the 'underground nature' of ibogaine treatment.

Drug interactions with:

drugs which affect the same neurotransmitters.

Finding a Practitioner

Finding a well-trained practitioner can be
difficult. You can also always ask your general practitioner (GP)
or mental health professional.

It may be useful to consult with your local
drug information service, and to find a health professional with
special expertise in this area, or use services recommended by your
GP or hospital. There are professional herbalists who belong to the
National Institute of
Medical Herbalists. They are trained and often work in
a private setting. Most are not medically qualified.

Useful websites

Food and Behaviour
Research:this website has
information about a wide variety of conditions where behaviour,
learning and mood are linked with food and nutrition. You can
browse this information by condition.

MedlinePlus: This is a
website run by the US National Institute of Health. The homepage
has a search option allowing you to type in different keywords so
you can retrieve the information you want. Typing the keyword
“alternative medicine” or “drug information” will direct you to the
relevant sites.

Natural Medicines
Comprehensive Database: A subscription-only website
with extremely detailed and comprehensive information on all types
of natural medicines. It is cross-referenced with the scientific
literature, and contains features such as a natural product
effectiveness and drug interaction checker. It also allows
condition-specific searches and offers tutorials on specific
topics. Patient hand-outs can be downloaded.

Quackwatch: A
non-profit corporation whose purpose is to combat health-related
frauds, myths, fads, fallacies, and misconduct. This website can be
helpful when unusual treatments are suggested, particularly if a
lot of money is to be paid in advance. Some people may find the
website too provocative and sceptical - click onto the “cheers and
jeers” section to get a flavour of the site.